2009
26th ANNUAL KCKL/KLVQ
Greater Cedar Creek Lake Bass Tournament

ENTRY BLANK

$65.00 FEE PER DAY
(if paid by March 21, 2009)
$70.00 After 3/21/2009

_____ YOUTH ENTRY (under16)
$10.00 per day

NAME(please print)____________________________________________________
Address_____________________________________________________________
City_____________________________________________Zip_________________
Phone_(_____)_____________________SS#_______________________________

I hereby enter KCKL/KLVQ TWENTY SIXTH ANNUAL GREATER CEDAR CREEK LAKE BASS TOURNAMENT to be held March 28 & 29, 2009. I have read and understand the rules and release KCKL/KLVQ and it's agents of any liability for any claim, personal injury, accidents, damaged, lost or stolen property. I enclose check ( ) money order ( ) in the amount of $____________as entry fee. If I place for any prize, I will submit to a polygraph and/or other appropriate tests or be disqualified, and will abide with such results.

Contestants ratifies and approves entry in the KCKL BASS TOURNAMENT made on (his)(her) behalf by another and agrees thereby to be bound by all rules of the tournament.

Signature__________________________________________________________________

FOLLOWING TO BE FILLED OUT BY PARENT OR GUARDIAN OF PERSON UNDER ENTERING BASS TOURNAMENT. As (parent) or (guardian) of the above-named youth who is under 16, I hereby consent to (his) (her) submitting to a polygraph test should (he) (she) qualify for one of the prizes.

Signature__________________________________________________________________
Parent or Guardian



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